Normozoospermia: Every Man’s Wish

The volume of the sample must be over 2 ml, it must contain over 20 million sperm/ml, 25% of which must have good motility and at least 4% must look normal.

As specialists in infertility, we’ve been warning about the gradual worsening of sperm quality for years. Thus, the day in which a patient analizes his semen for the first time has become a very important day. They’re usually nervous and want to do everything that’s in their hands for it to be a success.

They receive the following instructions: semen must be obtained through masturbation. The sample must be handed in within a sterile container that can be purchased at a chemist’s (same container as the ones used for urine samples), trying to collect the whole ejaculated matter. It must be left at the clinic within an hour after collection. Sexual abstinence is advised during the previous 3-5 days.

The adventure begins.

How the sample is obtained… It may seem obvious but let me clarify it a bit more, just in case as we don’t want any surprises further on… For instance, it’s not uncommon we see samples that look like a crime scene under the microscope: a sperm massacre by spermicide because the patient has used a preservative.

How to seal the container… Many want to ensure the sperm won’t escape so they thoroughly wrap it up in cellophane and some even secure the lid with sticking plaster. The treasure’s packaging is important and here patients let their creativity take in. Some bring them covered in the most beautiful aluminum wraps or in colorful bags from places where they buy their food, clothes, etc. Whenever we’ve conducted studies on young population some have even brought their samples in jars of jam and very narrow test tubes (how did they ever aim it in there!?)

How to carry the container… If the sample is brought to us by car, the typical question that rises is whether they should have heat or air conditioning on. It certainly doesn’t affect the sample. Once, a patient who brought it by motorcycle had it in his pocket and it fell – his sperm happened to land all over the front glass of the car behind him.

How to bring it on time… Patients ejaculate and sprint to us it before an hour goes by. When they finally reach the clinic, they’re surprised we don’t pick it up and run to the lab as if it were a relay race. They’re always grateful we don’t look into it as they feel they’ve performed poorly and the sample’s too small. It’s true, 2-5 ml take up very little space! It’s a very common question: should I be filling it more? The answer lies in sperm’s quality, not quantity. The liquid is produced in seminal vesicles and in the prostate and its merely a vehicle for spermatozoids. We do know good sexual stimulation will give place to a better sample.

How to prevent samples getting mixed… This worries both patients and us. We always ensure the tag on the container reads the patient’s name in front of him and check whether his face matches the photo of him we keep in his medical history. Whenever the wife brings the sample, she must also bring a signed consent form from the male. Additionally, the lab also undergoes strict controls which include a biologist acting as a “controller”, checking all the identifications. The rest of the team can only continue to work when they’ve received his approval.

How will I be sexually aroused in a hospital… Worried because his wife is in an operating room meanwhile, the man believes she’s gone through a whole medical process whilst he “only” must give a sperm sample and he fears to fail. Rooms are equipped with erotic visual supplies and despite their fears they’re usually successful, and they’re also fast! Us women who work in this area are surprised that the average time is 5 minutes! Nevertheless, some get stuck and can’t perform. There’s a procedure for these cases: first, we must know whether it’s erection or ejaculation he can’t achieve. Then, treatment is applied before a second attempt: if he doesn’t achieve erection we give him Viagra-like pills, while if they can’t ejaculate we try to relax them by letting them take a walk in a nearby park or with Valium-like pills. If they stil can’t achieve ejaculation, the procedure includes Plan B, which is the aspiration of sperm from the testicle (a very simple intervention).

Finally, I’d like to comment on some issues related to the sexual abstinence on the previous days. The standard for a seminogram are 3 to 5 days, though the number is simply an attempt to reflect reality as it’s the average frequency with which couple have sex. Nevertheless, when the sample is handed in for treatment, we give less importance to previous abstinence because the male who hasn’t ejaculated for days ejaculates a greater volume but old and dead sperm are gathered in it, and thus, DNA fragmentation is worse. Additionally, ICSI requires very few spermatozoids.

Hence, you can imagine their great relief when the adventure reaches its end and the report reads “normozoospermia”!

I recently obtained the test report out of curiosity. I am trying for the child. Report says:
90million count, 7.7pH, normal viscosity, 85%/65% motility for 1hr/2hr, Oval – 90%.
However, WBC is 3-4 HPF & Epithelial is 1-2 HPF, with Agglutination shown as “++”.
I searched in the web for the explanation, and now worried for the ++ indication.
Kindly provide your opinion as to whether this is normal to get my partner impregnated.
I shall be very much grateful to you for your kind advice.

Dear Krishna,
Agglutination “++” is a quantitative valuation used in the reference laboratory. Agglutination specifically refers to motile spermatozoa sticking to each other, head-to-head, tail-to-tail or in a mixed way. The motility is often vigorous with a frantic shaking motion, but sometimes the spermatozoa are so agglutinated that their motion is limited.
Agglutination “++” isn’t correct form. The correct evaluation of the agglutination it is in grades 1-4 (WHO laboratory manual for the Examination and processing of human semen, Fifth edition). Sperm agglutination can indicate the presence of sperm antibodies or a bacterial infection.
Kind Regards,

Hello, My Husband and i are currently looking for a Kid and previous we visited the Doctors Office, but apparently the results weren’t very good at all, He was found with no Sperm Count in his semen. Meanwhile we are very confused as to what to do next, please advice of what should be the possible solution…
Eagerly waiting on your reply

Dear Annette,
Thank you for joining our Blog.
Your husband has a azoospermia, which is the name for the absence of sperm in the ejaculate. Azoospermia may be obstructive (OA) or nonobstructive (NOA). In the first case sperm production in the testes is more or less normal but can not leave them due to the obstruction of the seminal tracts at some point. In nonobstructive case there is a production problem, in most cases it is the lack of sperm-producing cells, the origin of this deficit is often unknown. In 50-60% of the NOA, there are isolated sources of sperm production in testes. In both cases OA and NOA sperm can be retrieved surgically from testes to use for an IVF-ICSI. In 100% of OA cases, in 50-60% of NOA cases. Besides, the NOA have a worse prognosis, since they are associated with chromosomal or genetic problems that may have an impact on the result of the reproduction technique or on offspring.
Kind Regards,

Since the concept of fertility is clinical (in the realm of the couple) and non-analytical (single), and it is mainly proven by having children and not by having normal sperm analysis, your question Am I fertile? can’t be answered restrictively.
Your spermogram shows normozoospermia, i.e. all values are above the so-called reference lower limit established by the WHO.
If we stick to the fact that this “reference lower limit” has been established from the values of sperm samples from fertile men, 95% of men who had equal or higher values than this limit achieved a pregnancy within a maximum of 12 months. Your sperm analysis would fulfill these criteria.

Dear Mr:
The semen analysis is normal so you should not have problems to get a natural pregnancy.
Testosterone levels vary throughout the day, this kind of test should be done first thing in the morning. You should repeat in 2 months the test of testosterone. This is the total testosterone but the biologically active is free testosterone. The total one could be decreased and the free one could be normal. Although it was not the situation, under any circumstances you don’t need to do a testosterone replacement therapy because it would because it may cause a decrease in the production of sperms.
Best Regards

I am married for last 2 and 7 Months. Male. We did not yet have baby till now inspite of trying . I am mentioning the semen analysis report here (did this month Aug 18): Volume 2 ml, Liquefaction : Completely liquefied, PH alkaline, sperm count 30 million (almost 5 days abstinence), sperm motility 60% actively, 25% feebly motile, 15% non motile; sperm morphology 60% within normal limits, Pus cells Leukocytes 2-4/HPF, Epithelial cells 1-3/HPF, Germ cells – present, RBC – Nil, Comment: Normozoospermia. However almost 3 years ago i did the semen analysis where my sperm count was 80 million but within 2 years and 7 months it came to 30 million. Am i okay to have a baby and what should i do to stop the continuation of sperm loss? I would be happy if i get your few words on this issue. Thank you so much.

Considering that the diagnosis is normozoospermia, I guess 30 million are per ml., which in 2 mL make up for 60 million in total, which is far more than the 39 million, which would be the lower limit below. Production of sperm cells is subject to fluctuations, hence there are not 2 seminograms that are equal in number. Both your seminograms are normal in figures. Regarding motility, I guess 60% refers to progressive motility, being the lower limit below 32%; so, it is also normal, as are morphology and the rest of paramenters.
I wouldn’t take it as a decrease in production, but as a physiological fluctuation, since both ejaculates should be considered as potentially fertile.

If you would undertake another seminogram, I am sure it would turn out different too.

More abstinence days don’t increase the number of sperm cells: with 2-3 days is enough to evaluate your seminogram.

Dear Ogro,
The active motility of 20% is lower than normal (32%), however, this deficit would be offset by the number of 90 million sperm / ml (normal 15 M / ml).
I would recommend you repeat the seminogram.

Dear Sabuj,
All semen results are normal and therefore it should be considered potentially fertile.
The presence of “Pus Cell” may be indicative of a seminal infection so it is advisable to perform a semen culture to rule out infection.

The number of sperm is normal but the percentage of sperm with progressive mobility is less than normal, so the probabilities of natural pregnancy are significantly diminished.
Consult with a specialist.

Is it All Normal ? Married , Trying for baby.( Partner have some Problem, Her treatment going on) My Age 32 .I am little smoking ( 4/5 Stick per day) Nothing els .Weight 58Kgs , High: 05 feet. For More best quality sperm what should i do? Waiting for your suggestions.

Dear Sumon Dey,
Thank you for joining us.
Number of spermatozoa within the norm.
Mobility slightly decreased 25% (normal 32%).
Consult with a uro-andrologyst to identify possible causes of decreased mobility and indicate treatment.

Your spermogram shows normozoospermia, i.e. all values are above the so-called reference lower limit established by the WHO.
Since the concept of fertility is clinical (in the realm of the couple) and non-analytical (single), and it is mainly proven by having children and not by having normal sperm analysis, your question Am I fertile? can’t be answered restrictively.
Kind Regards,

Dear Heratul,
Normozoospermia means that all parameters are within the normal range, therefore there is no indication for a treatment.
Considering that semen could have physiological fluctuations, I would suggest you to repeat the seminogram in 4 weeks and in another laboratory.

The seminogram’s result is not normal since there is a decrease in the active mobility that should be 32%.
We recommend to repeat the seminogram after one month from the date of this one and if it is possible in another laboratory.

It is possible but is unlikely due to the low seminal volume. An andrological study is necessary since some of these causes may be related to genetic abnormalities that can have repercussions on offspring.

The volume is less than normal. In most cases it is due to low sexual stimulation and / or low duration of the same.
The number of spermatozoa is at the minimum of what is considered normal.
Progressive mobility is slightly lower than that considered normal (32%).
WHO advises to conduct two separate seminograms 4 weeks between them.
We suggest to repeat the seminogram

This is my report but my wife is not getting pregnant. Test is done for her also but she is also fertile. I want to know that in my report it shows Active: 35 is this ok and pls any problem in my report mention that pls

Had azoospermia due to slow movement and low count.
last test showen normozoospermia! – there is hope!
question:
anything to DO and NOT TO DO to keep it normal : food , drinks ( coffee alkohol red bull)
i am 32 so i do a lot of those !
please advise!

Azoospermia is the absence of spermatozoa, if you previously had low mobility and low count what you probably had was oligoastenozoospermia.
Sperm production is subject to physiological fluctuations, so a single seminogram is not sufficient to establish a diagnosis.
If you now have normozoospermia you should repeat the analysis in 3 months.
We suggest to maintain a healthy lifestyle, with proper nutrition and physical exercise and to avoid excessive alcohol and coffee as well as energy drinks.

The result of the analysis is normal, so the semen is potentially fertile.
In order to be able to indicate what modifications you must make in your lifestyle, you must know what your lifestyle is. Either way, your lifestyle does not seem to have a negative impact on your fertility.

The result of the analysis is normal, so the semen is potentially fertile.
In order to be able to indicate what modifications you must make in your lifestyle, you must know what your lifestyle is. Either way, your lifestyle does not seem to have a negative impact on your fertility.

Number, motility and morphology within normal values.
The presence of Pus Cells: 5-6 / hpf, may indicate the presence of infection that should be discarded by performing a semen culture and proving positive to perform antibiotic treatment.

Dear Sir,
We are trying last one year. We have consulted with gynecologist from February this year. My wife has no problem. I also abstain myself from smoking since February. But result is dissappointing.

In order to make a correct clinical assessment, the WHO advises at least 2 sperm test (4 weeks between the), so this opinion is limited to the sperm test provided.
The normal seminal volume is lower than normal (nv> 1.5 mL) in most cases is due to lack of sexual stimulation, short duration of the sexual stimulation or loss of part of the sample, although there may also be pathological causes .
Although the sperm concentration is normal (nv> 15 M / mL) the total number of spermatozoa is lower than normal (nv> 39 M / mL) since in this case, being the volume of 1 mL and total sperm concentration the same: 28 M / mL and 28 M in total. This total provides the information about the testicle.
Motility (nv> 32% PR) and morphology (nv> 4%) are normal.

In summary, the total number of sperm that can achieve pregnancy is slightly decreased in this ejaculate.

To carry out a new treatment, it is necessary to check with a doctor if everything is fine. So I recommend that you go to a clinic where a professional will give you an assessment and instructions to start over.

Sir can you please advise
Absistence more than 10 days
My semen analysis report
Viscosity thick
Ph alkaline
Total volume 2.0 ml
Pus cells 50-60hpf
Erythrocytes10-15
Total count 40 million but it shows non mobile =100% dead …however patient didn’t have erection while sample was collected what do you suggest

Dear Sakib,
The spermiogram presents several altered parameters.
First of all the days of abstinent are excessive, it is not necessary more than 5 days.
There is a high number of Pus cells, which suggests a possible infection that could be the cause of the lack of motility of the sperm. It is necessary to make a culture of sperm.
The number of erythrocytes is also higher than normal, it could be due to infection or inflammation.
Consult a specialist urologist or andrologist.

Dear Luchi
First of all I would like to highlight my mistrust towards the laboratory where you have performed those test. According to the way they show the results, it seems they don’t follow the criteria established by the World Health Organization regarding the sperm samples, especially regarding their motility and morphology.
The sperm volume is below the normal standards, as it should be >1.5 ml.
The sperm number is within the normal standards, but unfortunately I can’t properly assess their motility and morphology.
The most remarkable thing is the high number of pus cell-15-20/HPF, leucocytes or white blood cells founded. The leucocytes are inflammatory cells and their presence suggests there might be an infection. Suggestion is not a confirmation though, this is why it would be necessary to perform a sperm culture. In case of positive result, it would be necessary to perform the culture with the right antibiotics according to the antibiogram.

The spermatozoid percentage with progressive motility (a+b) is lower than normal (32%).
However, this deficiency is compensated by the total count of sperm, so the total number of sperm with progressive motility present in the ejaculated should be higher than the lower normality limit.
Therefore we can assume that the fertile potential present in the ejaculated should be normal.
Best regards.

The presence of “White Blood Cells per High Power Field (WBC / HPF)” suggests a possible infection, but to have a real diagnosis of infection you should perform a semen culture.
You’d better consult a specialist.
Regards

Even if the spermatozoa numbers is normal, there is a severe motility problem (8% of progressive motility, when a normal minimum would be 32%). Because of that, the probabilities of natural pregancy are dicreased. Furthermore, there is a number of leukocytes (pus cells), which indeed suggest a possible infection. Since an infecion can reduce the sperm motility, the first thing to do would be a semen culture for common germs, an ureaplasma and a mycoplasma.

First thing to determine is see if there is a known cause that could be responsible for the motility dicrease. As I told you in my previous post, the rate of pus cells observed in your sperm are higher than usual. This could be due to a sperm infection . In order to rule out infection it is necessary to carry out a sperm culture. An infection could cause a dicrease in motility. Please check with a urologist- andrologist.

Your seminogram shows a 55% of abnormal spermatozoa, which indicates that you might have some difficulties to get your partner pregnant. Abnormalities in the spermatozoa morphology do not allow to properly pierce the egg and fecundate it. That is why I would suggest you to go to a centre specialized in reproductive medicine to make a selection of healthy sperm, freeze it and have it ready for a future implantation.

Dear Hafizur,
If you have been to a specialist that has suggested this treatment for the next 3 months, then it is probably the one that suits you best to solve your problem.
Follow his advice.
I hope everything will turn out alright.
Kind regards.

The data in your seminogram indicates that you should not have any problem in getting your partner pregnant. According to WHO, a sperm with 20 million spermatozoa per ml. is considered normal (yours has 50 million/ml). Furthermore, over half of your spermatozoa have an optimal motility to reach the fallopian tubes and fecundate the egg (65% of motile spermatozoa in your sperm). That is why I can tell you that you havce a lot of guarantees to get to fecundate your partner’s egg.

The only remarkable thing to comment from your report is the hypomotility of your spermatozoa. This will prevent in many occasions to get your partner pregnant, since a good sperm motility is a prerequisite for the spermatozoa to reach the fallopian tubes and fecundate the egg.

I would advise you to visit a reproductive medicine centre, so that a professional can evaluate and indicate what technique suits you better to get a sperm sample with the ideal motility to get a pregnancy.

Motility is either not correctly expressed or the laboratory has gotten it wrong when transcribing the data: the sum of motile and immotile should be of 100%; in this case, it adds up to 70%, so there is a mistake there.

The count of WBCs is normal.
The percentage of progressive motility is diminished, since the normal value should be 32% or over that figure, and in your case it is 15%. However, you should take into account that this deficit is compensated by the total count of spermatozoa. If we stick to the inferior limits of your sperm analysis, 32% of 39 million in total would mean 12 million spermatozoa with progressive motility. In your case, this means 15% of 285 millions in total, hence 42 millions. A sperm analysis is not a categoric test to differentiate fertile from sterile, it just tells us about a bigger or smaller probability of pregnancy.
In fact, up to a 20% of men who do not have normal sperm analysis do manage to achieve a natural pregnancy. My advise would be that if after a year of unprotected sexual intercourse your partner has not achieved a pregnancy, then you should consult with an specialist.

Regarding the results of your sperm analysis and according to the parameters validated by the World Health Organization (WHO) I can tell you that the values of your analysis are within normal parameters, so that you should be able to get your partner pregnant if having regular sexual intercourse (2-3 times a week) without protection.